Each tablet contains: Salabmisri (orchis mascula) 78 mg • Kokilaksha (astercantha longifolia syn. hygophila auriculata) 38 mg • Vanya Kahu (lactuca scariola syn. l.serriola) 20 mg • Kapikachchhu (mucuna pruriens) 20 mg • SARAPAGANDHA Suvarnavang (mosaic gold, unsublimed tin preparation) 20 mg • Sarpagandha (rauwolfia serpentina, standardised to contain 1.5 mg of the total alkaloids) • Vriddadaru (argyreia speciosa syn. a.nervosa) 38 mg • Gokshura (tribulus terrestris) 38 mg • Jeevanti (leptadenia reticulata) 38 mg • Shaileyam (parmelia perlata) 20 mg.
Brand name products often contain multiple ingredients. To read detailed information about each ingredient, click on the link for the individual ingredient shown above.
Below is general information about the effectiveness of the known ingredients contained in the product Speman Forte. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
There is insufficient reliable information available about the effectiveness of Hawaiian baby woodrose.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Speman Forte. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
POSSIBLY SAFE ...when used orally and appropriately. Powdered formulations of cowhage seed that are standardized to provide levodopa 75-400 mg daily have been used with apparent safety for up to 20 weeks (7020,7203,97266).
POSSIBLY UNSAFE ...when the hair of the cowhage bean pod is used orally or topically. The bean pod hairs are strong irritants and can cause severe itching, burning, and inflammation (18).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
LIKELY UNSAFE ...when used orally (17,5301). The seeds of Hawaiian baby woodrose have effects similar to the hallucinogen lysergic acid diethylamide (LSD), including flashbacks and hallucinations. In one case, severe agitation led to death due to jumping from a high point (5301,97867,103857,103858,103860).
PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally (17,5301); avoid using.
POSSIBLY UNSAFE ...when used orally. Indian snakeroot contains small amounts of the drugs reserpine and yohimbine. Although most adverse effects to Indian snakeroot appear to be mild, higher doses can cause cardiovascular side effects including bradycardia and hypotension. Prolonged use can cause depression in some people (94330,94331,94332,94438,94440).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
The reserpine alkaloid constituents appear to cross the placenta and are excreted in breast milk (4260).
LIKELY UNSAFE ...when the spine-covered fruit is used orally. There have been reports of bilateral pneumothorax and bronchial polyp after oral consumption of the spine-covered fruit (818).
PREGNANCY: POSSIBLY UNSAFE
when used orally.
Animal research suggests that tribulus might adversely affect fetal development (12674); avoid using.
LACTATION:
Insufficient reliable information available; avoid using.
Below is general information about the interactions of the known ingredients contained in the product Speman Forte. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Theoretically, concomitant use of cowhage and anesthesia might increase the risk of arrhythmias.
Details
Cowhage contains levodopa (7020,7205,46334,46336,94723,94724). Use of levodopa with cyclopropane or halogenated hydrocarbon anesthesia has led to arrhythmias. Other anesthetics have not been implicated (15). Use other anesthetics in patients taking cowhage or tell patients to stop taking cowhage at least 2 weeks before surgery.
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Theoretically, concomitant use of cowhage and antidiabetes drugs might increase the risk of hypoglycemia.
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Animal research shows that cowhage might have hypoglycemic effects (7221).
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Theoretically, use of cowhage might decrease the clinical effects of antipsychotic drugs.
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Theoretically, concomitant use of cowhage and guanethidine might increase the risk of hypotension.
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Concomitant use can increase the risk of levodopa-related adverse effects.
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Theoretically, concomitant use of cowhage and methyldopa might increase the risk of hypotension.
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Theoretically, concomitant use of cowhage and non-selective MAOIs might increase the risk of hypertensive crisis.
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Theoretically, use of TCAs might reduce the levels and clinical effects of cowhage.
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Theoretically, concomitant use may increase the risk for serotonergic adverse effects.
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Hawaiian baby woodrose contains chemicals which might increase serotonin levels. Combining serotonergic drugs with Hawaiian baby woodrose might increase the risk of serotonergic side effects including serotonin syndrome and cerebral vasoconstrictive disorders (8056).
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Theoretically, taking Indian snakeroot might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
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Theoretically, concomitant use of Indian snakeroot with antidiabetes drugs might increase the risk of hypoglycemia.
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Theoretically, concomitant use of Indian snakeroot and antihypertensive drugs might increase the risk of hypotension.
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Theoretically, concomitant use might increase the risk of adverse effects.
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Theoretically, taking Indian snakeroot with beta-blockers might increase the risk of bradycardia and/or hypotension.
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Indian snakeroot contains small amounts of reserpine. Reserpine causes catecholamine-depletion (15). Concomitant use of Indian snakeroot and beta-blockers might increase the risk or bradycardia and/or hypotension.
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Theoretically, taking Indian snakeroot might cause additive sedative effects.
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Theoretically, Indian snakeroot might inhibit CYP2D6 enzymes and reduce the metabolism of CYP2D6 substrates.
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Indian snakeroot contains small amounts of the drug yohimbine. In vitro research shows that yohimbine inhibits CYP2D6 enzyme activity (23117).
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Theoretically, taking Indian snakeroot with digoxin might increase the risk of bradycardia.
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Theoretically, taking Indian snakeroot with ephedrine might alter the effects and side effects of ephedrine.
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Theoretically, taking Indian snakeroot with levodopa may reduce the effectiveness of levodopa.
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Theoretically, taking Indian snakeroot with MAOIs might cause additive effects.
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Theoretically, concomitant use might cause additive effects.
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Theoretically, concomitant use might alter the effects of Indian snakeroot and increase the risk of adverse effects.
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A small clinical study in patients taking TCAs for at least 4 weeks shows that receiving doses of intravenous yohimbine, a constituent of Indian snakeroot, 2.5-20 mg daily for up to 7 days precipitates severe anxiety, agitation, and tremor (105881). Also, concomitant use of TCAs with Indian snakeroot may decrease the effects of other rauwolfia alkaloids (15).
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Taking tribulus with antidiabetes drugs might increase the risk of hypoglycemia.
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Clinical research shows that Tribulus can lower blood glucose levels in adults with type 2 diabetes who are taking antidiabetes medications (97327).
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Theoretically, taking tribulus with antihypertensive drugs might increase the risk of hypotension.
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Theoretically, tribulus might increase the levels and clinical effects of lithium.
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Tribulus is thought to have diuretic properties (12681). Due to these potential diuretic effects, tribulus might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.
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Below is general information about the adverse effects of the known ingredients contained in the product Speman Forte. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General
...Orally, adverse effects to cowhage seem to be rare; however, a thorough safety evaluation has not been conducted.
Topically, cowhage bean pod or seed may be unsafe.
Most Common Adverse Effects:
Orally: Diarrhea, flatulence, mucosal irritation.
Topically: Erythema, pruritus, rash.
Cardiovascular ...Orally, cowhage has been reported to cause palpitations (7021,7203)
Dermatologic
...Orally, ingestion of hairs from the bean pod or seed can result in significant mucosal irritation and should be avoided.
Topically, hairs on cowhage bean pod or seed can cause severe pruritus (6898). Symptoms include severe itching, burning, inflammation, and erythematous macular rashes (18,6898). Symptoms resolve spontaneously within several hours, but may also be relieved with antihistamines (6898). The hairs can be removed from the skin by washing, but the hairs can also be retained, and transferred to other people, in fabrics and carpets. Clothing and other materials that come in contact with cowhage hairs should also be thoroughly washed (6898).
Gastrointestinal ...Orally, cowhage has been reported to cause flatulence, diarrhea, and dry mouth (7021,7203). Orally, a specific powdered cowhage seed extract (Zandopa, formerly HP-200; Zandu Pharmaceuticals) has been reported to cause nausea, abdominal distention, and vomiting in clinical research when taken in amounts of 22.5-67.5 grams divided into 2-5 doses per day (7020).
Musculoskeletal ...Orally, dyskinesia has been reported in clinical research in about 3% of patients taking a specific powdered cowhage seed extract (Zandopa, formerly HP-200; Zandu Pharmaceuticals) 22. 5-67.5 grams divided into 2-5 doses daily (7020).
Neurologic/CNS ...Orally, cowhage has been reported to cause headaches (7021,7203). Orally, insomnia has been reported in clinical research in about 3% of patients taking a specific powdered cowhage seed extract (Zandopa, formerly HP-200; Zandu Pharmaceuticals) 22.5 grams to 67.5 grams divided into 2-5 doses daily (7020).
Psychiatric ...In a case report, cowhage caused an outbreak of acute toxic psychosis. Symptoms of psychosis included confusion, giddiness, agitation, hallucinations, and paranoid delusions. The cowhage-induced psychosis was successfully treated with intravenous chlorpromazine (7021).
Other ...Orally, cowhage has been reported to cause sweating and changes in urine color, (7021,7203). Theoretically, due to the levodopa constituent, cowhage is likely to cause the same adverse effects that have been attributed to purified, prescription levodopa. Some of these side effects include elevated liver enzymes, respiratory disturbances, urinary retention, muscle cramps, and priapism (15). However, these effects have not yet been reported for cowhage.
General
...Hawaiian baby woodrose is generally regarded as unsafe for use.
Any benefits of therapy may not outweigh the risk of toxicity. The number of seeds needed to produce adverse effects differs for each individual.
Most Common Adverse Effects:
Orally: Dizziness, fatigue, hallucinations, hypertension, mydriasis, paranoia, sweating, tachycardia.
Cardiovascular ...Orally, approximately four homogenized Hawaiian baby woodrose seeds have been reported to cause temporary blood pressure elevation (103857). In one 18-year-old male, consuming 15 Hawaiian baby woodrose seeds resulted in tachycardia and hypertension. The patient also used cannabis, but symptoms were thought to be related to Hawaiian baby woodrose (103858). The number of seeds needed to produce adverse effects differs for each individual. Additionally, the alkaloid and lysergic acid amide contents vary from batch to batch (103857).
Dermatologic ...Orally, Hawaiian baby woodrose seeds can cause sweating (5301).
Gastrointestinal ...Orally, four homogenized Hawaiian baby woodrose seeds have been reported to cause nausea and vomiting (103857). The number of seeds needed to produce adverse effects differs for each individual. Additionally, the alkaloid and lysergic acid amide contents vary from batch to batch (103857).
Neurologic/CNS ...Orally, four homogenized Hawaiian baby woodrose seeds have been reported to cause fatigue lasting for 2 hours and tremor of the hands lasting for about 9 hours in one person (103857). Weakness, vertigo, and heaviness in the legs have also been reported (103857). The seeds have also been reported to cause auditory hallucinations and altered visual perception (5301,103857,103860). The number of seeds needed to produce adverse effects differs for each individual. Additionally, the alkaloid and lysergic acid amide contents vary from batch to batch (103857). Lysergic acid amide 2-5 mg is enough to cause hallucinations, with effects lasting 4-8 hours (5301,5304,97867).
Ocular/Otic ...Orally, Hawaiian baby woodrose seeds can cause blurred vision, dilated pupils, and involuntary, rapid, rhythmic movement of eyeballs (5301,103857).
Psychiatric
...Orally, four homogenized Hawaiian baby woodrose seeds has been reported to cause difficulty expressing thoughts, fits of laughter, and paranoia in one person (103857).
The seed has also been reported to cause mood elevation and anxiety (103857,103860). In an 18-year-old male, ingestion of 15 seeds resulted in erratic and bizarre behavior accompanying suicidal and homicidal ideation and depression. The patient also used cannabis, but symptoms were thought to be related to Hawaiian baby woodrose (103858). In one case report of a 29-year-old male, consuming an unknown quantity of soaked Hawaiian baby woodrose seeds and smoking cannabis resulted in severe agitation leading to a jump from a fourth-floor window and death (97867). In a 17-year-old female, ingestion of 6 seeds initially resulted in a euphoric and energetic mood, with increased socializing and school performance. The patient then developed problems with concentration, thinking, and sleep, with nightmares, anxiety, suspiciousness, and crying, resulting in hospital admission and treatment for psychosis with aripiprazole 10 mg daily and lorazepam as needed. Most symptoms resolved within 7 weeks; however, problems with concentration continued for several more weeks. Aripiprazole was discontinued 22 weeks after discharge (109536).
The number of seeds needed to produce adverse effects differs for each individual. Additionally, the alkaloid and lysergic acid amide contents vary from batch to batch (103857). Lysergic acid amide 2-5 mg is enough to cause hallucinations (97867).
General
...Orally, Indian snakeroot may be unsafe, particularly at high doses.
Most adverse effects are thought to be from the constituents reserpine and yohimbine.
Most Common Adverse Effects:
Orally: Abdominal pain, bradycardia, congestion, diarrhea, hypotension, increased appetite, nightmares, sedation, weight gain.
Serious Adverse Effects (Rare):
Orally: Atrial fibrillation, convulsions, depression, myocardial infarction.
Cardiovascular ...Orally, Indian snakeroot has been associated with reports of bradycardia and mild hypotension. These adverse effects are thought to be related to the constituent reserpine (94331,94440). Adverse reactions to reserpine also include angina-like symptoms (94328). At high doses, adverse effects related to yohimbine, another constituent of Indian snakeroot, include hypertension, tachycardia, palpitations, myocardial infarction, and atrial fibrillation (3312,17465,86801,91521). A supplement containing Indian snakeroot and several other ingredients (Carditone, Ayush Herbs) has been associated with reduction in blood pressure and increase in serum potassium levels (102838).
Dermatologic ...Indian snakeroot contains small amounts of reserpine and yohimbine and may theoretically cause some of the adverse effects associated with these constituents. Orally, reserpine can cause facial flushing, skin rash, and itching (94328). Yohimbine may cause rash, erythrodermic skin eruption, and exanthema (3312,3971,86878,86896).
Endocrine ...Indian snakeroot contains small amounts of reserpine and may theoretically cause some of the adverse effects associated with this constituent. Orally, reserpine can cause galactorrhea and breast enlargement (275,94328).
Gastrointestinal ...Orally, Indian snakeroot has been associated with increased or decreased appetite, diarrhea, nausea, vomiting, and abdominal pain (94332,94438,94440). Yohimbine, a constituent of Indian snakeroot, has been associated with nausea, vomiting, increased salivation, diarrhea, and gastrointestinal distress (3970,17465,86780,86786,86804,86827,86896). Reserpine, another constituent of Indian snakeroot, may cause gastrointestinal irritation and activation of peptic ulcers (15,19).
Genitourinary ...Indian snakeroot contains small amounts of yohimbine and may theoretically cause some of the adverse effects associated with this constituent. Yohimbine may cause dartos contraction or decreased libido in some patients (86786,86882).
Hematologic ...Indian snakeroot contains small amounts of reserpine and yohimbine and may theoretically cause some of the adverse effects associated with these constituents. A case of drug-induced agranulocytosis has been reported following prolonged use of oral yohimbine (86877). Reserpine may cause thrombocytopenia (275).
Immunologic ...There is one report of a hypersensitivity reaction to yohimbine, a constituent of Indian snakeroot. Symptoms included fever, chills, malaise, itchy, scaly skin, progressive kidney failure, and a lupus-like syndrome (6169).
Musculoskeletal ...Orally, Indian snakeroot has been associated with muscle aches and cramps (94438).
Neurologic/CNS ...Orally, Indian snakeroot may cause headaches, feeling cold, dizziness, drowsiness, nightmares, and mild sedation (94331,94332,94438,94440). Indian snakeroot contains small amounts of reserpine and yohimbine and may theoretically cause some of the adverse effects associated with these constituents. Doses of reserpine of greater than 0.5 mg daily can increase the risk of side effects. In extremely large amounts, Parkinson-like symptoms, extrapyramidal reactions, and convulsions may occur (15,94328,94332). Orally, yohimbine has been associated with reports of tremulousness, head twitching, seizures, loss of consciousness, decreased energy, dizziness, vertigo, headache, feeling cold, flushing, diaphoresis, and paralysis (11,18,3312,3971,17465,86786,86801,86804,86827,86896).
Oncologic ...Indian snakeroot contains small amounts of reserpine and may theoretically cause some of the adverse effects associated with this constituent. Some preliminary research suggests a link between reserpine and an increased risk of breast cancer; but this has not been confirmed in further research (94328).
Psychiatric
...Orally, Indian snakeroot can cause emotional upset or depression, especially in people with prior episodes.
This appears to be related to the constituent reserpine (94332,94438). One study shows the rate of depressive episodes is similar for patients taking Indian snakeroot and those taking reserpine (94438). Some research suggests that the risk of depression might increase with dose or the length of use. When taken for less than 40 days, depression did not occur in patients taking Indian snakeroot or reserpine (94330).
Indian snakeroot contains small amounts of yohimbine and may theoretically cause some of the adverse effects associated with this constituent. Orally, yohimbine may increase anxiety and impulsivity (17465,86784,86810).
Pulmonary/Respiratory ...Orally, Indian snakeroot can cause nasal stuffiness or congestion and shortness of breath (94330,94332,94438,94440). One study shows that Indian snakeroot may increase the risk for nasal congestion more than the constituent reserpine. (94438). Reserpine is also associated with rare reports of allergic reactions that can precipitate asthma (15,94328). Another constituent of Indian snakeroot, yohimbine, may cause bronchospasm, tachypnea, cough, sinusitis, and rhinorrhea (17465,86825,86850,94112). Excessive doses of yohimbine can cause respiratory depression (1118).
Renal
...Orally, Indian snakeroot may cause increased urination (94332).
Indian snakeroot contains small amounts of yohimbine and may theoretically cause some of the adverse effects associated with this constituent. A case of acute kidney failure related to yohimbine-induced systemic lupus erythematosus has been reported (6169).
Other ...Orally, Indian snakeroot has been associated with reports of weight gain (94438).
General
...Orally, tribulus seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Cases of liver and kidney injury, seizures, and chronic painful erection with impaired sexual function have been reported. Pneumothorax and bronchial polyp after consuming the spine-covered tribulus fruit have been reported.
Gastrointestinal ...Orally, tribulus can cause abdominal pain, cramping, nausea, vomiting, diarrhea, and constipation (92022,92027). However, in one study, the rates of these gastrointestinal complaints were similar for patients taking tribulus and those receiving placebo (92022).
Genitourinary ...In one case report, a patient taking two tribulus tablets (unknown dose) daily for 15 days presented to the local emergency department with a painful erection lasting 72 hours. The priapism was resolved with medical management; however, post-episode sexual function was impaired (92023).
Hepatic ...In one case report, a patient drinking tribulus water 2 liters daily for two days presented with lower limb weakness, seizures, hepatitis, and acute kidney injury. The patient's condition improved after hemodialysis and discontinuation of tribulus water (92069).
Neurologic/CNS ...Orally, tribulus has been reported to cause general excitation and insomnia. These symptoms were reversed upon discontinuation of the drug or decreasing the dose (78867). In one case report, a patient drinking tribulus water 2 liters daily for two days presented with lower limb weakness, seizures, hepatitis, and acute kidney injury. The patient's condition improved after hemodialysis and discontinuation of tribulus water (92069).
Pulmonary/Respiratory ...In one case report, a patient developed a bilateral pneumothorax after consuming the spine-covered fruit of tribulus (818). In another case report, a patient developed a polyp in the lobar bronchus of the right interior lobe due to the presence of a tribulus fruit spine (78852).
Renal ...In one case report, a patient drinking tribulus water 2 liters daily for two days presented with lower limb weakness, seizures, hepatitis, and acute kidney injury. The patient's condition improved after hemodialysis and discontinuation of the tribulus water (92069). In another case report, a healthy male taking one tribulus tablet (unknown dose) daily for a few months for bodybuilding purposes developed hyperbilirubinemia followed by acute kidney failure 2-3 weeks later. The patient was managed with intravenous fluids and a low-salt, low-protein diet (92025).
Other ...In one case report, gynecomastia was observed in a male weightlifter taking an herbal combination product containing tribulus. However, it is not clear if this adverse effect can be attributed to tribulus alone (78859).